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| ISBN-13: | 9780702266591 |
|---|---|
| Publisher: | University of Queensland Press |
| Publication date: | 11/02/2021 |
| Sold by: | Barnes & Noble |
| Format: | eBook |
| Pages: | 272 |
| Sales rank: | 455,540 |
| File size: | 2 MB |
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The Discontented Little Baby Book
All You Need to Know About Feeds, Sleep and Crying
By Pamela Douglas
University of Queensland Press
Copyright © 2014 Pamela DouglasAll rights reserved.
ISBN: 978-0-7022-5322-5
CHAPTER 1
HOW MUCH CRYING IS NORMAL?
Your newborn baby has not yet developed the capacity to speak to you using language. However, from birth she communicates her experience in a physical way: through the movement of her little limbs, through facial expressions, changes in skin colour and temperature, the way she turns her head, the sounds she makes, the changes in her breathing. We call her nonverbal communications her 'cues'. If she is experiencing something unpleasant, such as hunger, she is likely to begin telling us this with more subtle cues at first, such as grimacing and grunting, opening her mouth, moving her head from side to side in a rooting reflex or bobbing her head against your body. Then she may become increasingly agitated, with more jerky physical movement, small cries and grizzles, frowns, flushing, and back-arching. We might call these signs 'pre-cry cues', because soon they are likely to build into a full-blown cry if we are unable to work out what she needs or are unable to give it to her at that moment. A cry is a late cue. She's telling us that something is really wrong.
Of course, if your previously settled baby suddenly starts crying a lot, or has a temperature of 37.5 degrees Celsius or more, or vomits in a way that is different to his normal possetting, or if you have any other reason to think the baby might be unwell, it's important to see your doctor. Bouts of repeated or forceful vomiting after formula feeds, respiratory problems, or blood in the vomit or stool, for example, are signs that the crying baby needs to be medically assessed. However, less than 5 per cent of crying babies in the first few months of life have an underlying medical condition.
Mostly, unsettled babies are perfectly healthy. It's just that they cry and grizzle a lot, which happens to be heartbreaking for parents. Health professionals in the West have been saying for years that crying for prolonged periods is normal in the first 16 weeks, and won't hurt the baby. We definitely don't want families frantic with worry or lapsing into self-blame. We want to reassure them that the baby is healthy, and that this phase will pass without causing the baby any harm.
It's certainly true that most babies and their families are remarkably resilient, regardless of what happens, and will get through the crying period in the first few months without any long-term ill-effects. But when parents have such a strong feeling that their baby is signalling distress, our insistence that the crying is 'normal' can make it very difficult for them to trust in both their baby's communications and themselves.
If we consider problem crying in the first months of life across all cultures, we find that there are substantial differences between different societies. Babies initiate cries to communicate need or distress roughly the same number of times with a peak in the evening, no matter what culture they are born into, but they cry for longer durations over a 24-hour period in the West compared to traditional cultures. And interestingly, they cry for substantially longer periods in some Western societies, such as the United Kingdom, than in certain other Western societies, such as Denmark. Is it really normal, then, for a baby to cry a lot?
I think of 'normal' as a rhetorical device, a phrase that means, 'It's common in this part of the world; it's not your fault; it will pass without hurting the baby'. In this sense, crying in the first few months is normal. In 1962, Dr T Berry Brazelton described a 'normal crying curve' that had crying peaking at about 6 weeks. However, a recent meta-analysis of crying duration in twenty-four studies of Western babies demonstrates that they cry, on average, about 2 hours a day from birth until 6 weeks of age, before the crying tapers off to a little over an hour a day at 12 weeks, mostly disappearing by around 16 weeks (Figure 1).
So while crying a lot in the first 16 weeks is a normal phenomenon, this should never be confused with the belief that the baby's crying is not a communication of abject misery. Crying is a genuine appeal. Parents know this, in their bones.
Signs that often accompany crying and fussing
From both the medical literature and my years of experience in the clinic working with families and new babies, I've compiled a list of signs that often accompany a baby's crying and fussing:
• excessive feeding
• feeding refusal
• back-arching
• coughing, spluttering or gagging with feeds
• crying when put down
• vomiting
• frothy poo
• tight tummy
• copious belches and flatus
• very frequent waking
• won't 'self-settle'
• piercing shrieks.
Most parents will describe at least one or more of these signs in their unsettled baby, in addition to crying. They might tell me that their baby is unsettled, for example, because he wants to feed very frequently. He might pull away from the breast or bottle and back-arch. He might complain each time he is put down. He might posset or vomit a lot. He might have a lot of flatus or belching, a tight little tummy, and explosive frothy stools. He might seem to wake after only very short sleeps during the day. He might even be sleeping for only 30-minute or 1-hour periods during the night, a kind of excessive night-waking that happens sometimes in very little babies, in particular. Even though we know that, overall, an unsettled baby in the first few months tends not to wake up at nights more than others on average, he may not go back to sleep as easily, and night-time can be a nightmare of screaming, with everyone up and walking the floor.
Knowing risk factors doesn't help
Research has linked many factors with excessive crying in babies (for example, being premature or small-for-gestational age; nicotine exposure during pregnancy; having a mother who experienced antenatal stress, a previous depression or birth complications; or having a father who was depressed during the pregnancy). That doesn't mean these factors cause crying in babies, and it certainly doesn't mean that you are likely to have a crying baby if you or the baby fall into these categories. In fact, this information is of little use to families, since it is rarely in a parent's power to change any of these factors retrospectively, and listing them makes everyone more worried and guilty. (Having said that, not smoking during pregnancy is important for a number of reasons.)
Some babies, due to inborn temperamental tendencies, might also be more susceptible to problem crying if things like feeding go wrong in the first hours, days and weeks. If everything had gone well at the beginning, that same baby may not have become a crier. Then, the baby's behaviour in the first weeks affects the parents' perceptions of the baby's temperament, which affects the way they interact with the baby, which affects the baby's temperament.
In the brand-new relationship between babies and their parents, problems can quickly interact in a downward spiral of distress. The reason why your precious little son or daughter cries a lot and shows one or more of the signs I have listed is often complicated, and might be unknowable. As we will see, 'quick-fix' solutions, from medications to sleep-training, while very tempting for us all, usually don't help, and sometimes make things worse.
We need to take the time to understand what lies behind these various signs and begin the detective work of decoding patterns, if we are to make sense of your baby's crying and arrest that downward spiral.
Jane: 'I feel like such a bad mother.'
Jane comes in to see me with her first-born baby. He's 7 weeks old and is grizzling in the pram. She sits down and puts him in her lap. For a moment he looks around the room, but then his little face crumples and he begins to fret again, an incessant, upset, anxious sound.
'He wakes, oh, I don't know, half a dozen times from when we put him down for the night. It's really bad. I'm getting maybe 5 hours' sleep. And during the day he's either fussing like this or screaming, or sometimes sleeping, but he won't sleep for more than 20 minutes. When he starts to scream, there's nothing I can do.
'Oh, and he hates feeding,' she adds. 'At first he used to arch his back and pull off the breast, and wouldn't go back on even though I knew he was hungry. We started formula 2 weeks ago and he's been a bit more settled at night since then. The child health nurse has never been worried about his weight, but he still fights the bottle.'
'That must be hard for you,' I say.
Then suddenly, before I know it, she is in tears, shoulders heaving, wiping her eyes with the back of her one free hand and struggling to regain control. The baby arches his back on her lap and cries in earnest. She grabs three or four tissues from the box which is always ready on my desk.
'I feel like such a bad mother ...' she says with a sob.
'I can see you are an absolutely devoted mother!' I exclaim.
Jane confides through her tears, over the baby's racket, that she even feels ashamed to go out, for fear of attracting attention. For fear that others will think her incompetent because her baby cries.
Soon she is standing and jogging on the spot with the baby over her shoulder. He settles down a bit, and we converse to the sound of his grizzles. She tells me that her friend's baby girl lies in the cot cooing and gurgling before dropping quietly off to sleep. In fact, her friend's baby is happy to lie for an hour or two under a mobile gazing up at big red, yellow and blue felt flowers when her mother needs a break! She says her friend's baby only wants to feed every 3 or 4 hours, and sleeps through the night.
'But you see, baby's personalities are so different,' I explain, 'we just can't compare! Some babies are like your friend's little girl, although I have to say she's quite unusual. She's at the very far end of the spectrum of normal. Your little fellow is a high needs baby, that's for sure, right at the other end of the spectrum. Most babies lie somewhere in between, but they are all normal!'
Jane nods, jogging and patting.
Once I've finished asking the necessary questions, I check the baby over. He cries loudly as Jane undresses him then calms down a little, lying on the examination couch as we play with him and try to elicit a smile. He seems to be jumpy and easily startled, always on the edge of tears, with a subtle jerkiness to his movements. He's not easy to examine but I satisfy myself that he doesn't have a medical problem and is developing normally.
'Healthy babies are born with quite remarkable differences in their developmental maturity, too,' I explain. 'Boys are often much less developmentally mature at birth than girls. And the rates of development for different skills vary even for the same baby. One little girl might be quite late in being able to direct the movement of her hand, for example, but speaks words very early. She's still normal. Your little bubby is perfectly healthy, but you're right — he does cry a lot.'
Jane sighs in despair.
'We need to talk,' I say. 'I think there's probably quite a bit we can do to help settle him down. But did you happen to bring a bottle? Do you mind if I watch a feed first?'
CHAPTER 2THE CRYING BABY'S NERVOUS SYSTEM
The human brain is extremely immature at birth and its neuronal pathways are the most 'plastic' or mouldable of any other baby animal. As a result, human babies are remarkably adaptable to a wide range of infant care practices across cultures. Tiny babies have been laced into cradleboards and swung from poles in the long house, or carried naked in polar bear fur against the mother's back through subarctic winters, or fed and carried in paperbark coolamons. They've had bindings and boards applied to elongate their little skulls. They've been transported down dangerous mountain tracks in billums, like plants. The different approaches to infant care across the kaleidoscope of human cultures have tended to have one thing in common though – until very recent times the baby has been kept close to the body of his various caregivers.
A woman's brain, too, is primed by the hormones of pregnancy and birth to be particularly plastic in the first weeks and months of her new baby's life. In this post-birth period, women look to the culture around them to determine how to be a good mother. In some cultures, good mothers burn dry wood and leaves in a pit in the ground and pass the baby through fragrant smoke. Or they put a knife under the baby's sleeping place, or bathe him in very cold water, or keep him inside the house to avoid the evil eye.
Because of their special neuroplasticity, mothers and babies are remarkably resilient in the face of the profound challenges of early life, experimenting together in their communications, constantly rebalancing, readjusting and finding synchrony as best they can in their own unique circumstances.
In a baby, the three fundamental biological processes of feeding, sleeping and sensory integration cannot be understood in isolation because they are profoundly interdependent, particularly in the first six months. The nervous systems and hormones of the mother/caregiver and baby interact to regulate these processes. (For example, the baby's suckling, or even just eye-contact and cuddles with the mother, causes the mother's brain to release the hormone oxytocin, which stimulates milk let-down, decreases her blood pressure and cortisol levels and floods her with feelings of relaxation and love.) These rewarding interactions between the caregiver's and the baby's nervous systems evolved throughout our long evolutionary history to maximise the survival of our infants and drive the propagation of the human race. Quite simply, when there is plenty of mutual pleasure, we can say that the parent and baby are 'in sync'. When a baby cries a lot, and there is a lot of distress for the parents, too, everything feels 'out of sync'.
The mouldable baby brain
From the first seconds, minutes and hours of life, a baby's brain is learning. (In fact, that amazing little brain was even learning in the womb!) By learning, I mean that the brain is laying down new neuronal pathways in response to experience. For example, after the birth a baby may learn to associate her mother's breast with warmth, safety and satiety of both milk and sensation. Similarly, it is not uncommon in the West, though no-one intends it, that a baby may learn to associate her mother's breast with distress and frustration because she has a feeding problem that no-one around her is trained to identify or to help with. This negative association is sometimes so powerful that it results in breast refusal, overriding the fundamental human drive for nourishment and survival. Formula-feeding, in this situation, may come as a great relief to both mother and baby, helping them get back in sync. In another common example, a baby may learn to associate the feeling of sleepiness with warmth, safety and satiety of both milk and sensation. She may also learn to associate being put down to sleep with an unpleasant sensory boredom, loneliness, misery or sometimes even a primal terror.
Once you understand the remarkable plasticity of the baby's brain, you will know that:
1. You and the baby are a remarkably resilient team, so even if you don't feel in sync you're both likely to get through the crying period without any long-term ill-effects.
2. You need to give yourself time to be flexible and experiment and get to know your baby if you are to bring your hormones and nervous systems in sync.
3. Getting help early on when you feel out of sync helps to ensure that problems aren't reinforced in the baby's neuronal circuitry and therefore harder to address.
A sensitive first 16 weeks
The tendency of human babies to cry a lot in the first 16 weeks marks this as a period of great neurological sensitivity. A phenomenal blooming of synaptic connections occurs in the brain during this period. Extraordinarily rapid brain development means, for example, that the newborn's brain uses up to 80 per cent of his metabolic energy at rest.
In the womb, many of the earliest nerve cells to appear in your baby's developing cerebral cortex are 'subplate' neurons. Subplate neurons act as a gateway in the wiring up of the grey matter. They receive pioneering sensory pathways, or axons, and then project their own new axons into specific areas in the cerebral cortex so that the wiring up of cortical circuitry occurs correctly. Subplate neurons also persist in abundance in the early months after birth, clustered together in what's known as the cortical subplate remnant, still helping to organise neuronal circuitry.
The subplate remnant intrigues me because its persistence is unique to the brain of the human newborn, which is so immature at birth. It is a distinguishing feature of a time when neurons are dramatically blooming and synapsing, when the brain is fabulously mouldable – and when babies are prone to crying. During this period, neuronal pathways are laid down in direct response to the stimulation that the baby receives from his environment, becoming the templates for the rest of the child's brain development. The healthier and more diverse the sensory stimulation a baby receives in the first months after birth, the better the development of his brain circuitry.
(Continues...)
Excerpted from The Discontented Little Baby Book by Pamela Douglas. Copyright © 2014 Pamela Douglas. Excerpted by permission of University of Queensland Press.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
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Table of Contents
Contents
Introduction,1: How much crying is normal?,
2: The crying baby's nervous system,
3: Hunger pangs,
4: Tummy troubles,
5: For the love of milk,
6: Nourishing the senses,
7: A good (enough) night's sleep,
8: Enjoying your baby,
Appendix 1: An intimate history of mother–baby care in the English-speaking world,
Appendix 2: Neurodevelopmental challenges and the crying baby,
Some resources for parents,
About Possums,
Acknowledgements,
Selected references,
Index,